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Regional Manager – Utilization Management
Cleveland ClinicRegional Manager handling Utilization Management, overseeing operations across Cleveland Clinic Florida hospitals. Collaborating with healthcare teams to improve patient outcomes.
About the role
Key responsibilities & impact- Oversee daily operations of Utilization Management across the region
- Manage concurrent and retrospective reviews for medical necessity
- Collaborate with interdisciplinary healthcare teams
- Monitor utilization outcomes and lead performance improvement initiatives
- Provide leadership and oversight to Utilization Specialists
- Ensure compliance with nationally recognized screening criteria and regulatory requirements
- Identify opportunities to enhance operational effectiveness and patient outcomes
- Coordinate projects to attain goals
Requirements
What you’ll need- Bachelor's degree in Nursing, Healthcare Administration, or Business Administration
- Completion of an accredited Registered Nursing (RN) Program
- Proficiency with standard office equipment, including copiers, fax machines, personal computers, Microsoft Office, and clinical and financial computer systems
- Three years of nursing clinical experience
- Two years of recent Utilization Review/Care Management experience
- One year of healthcare management experience
- Current valid license in the State of Florida as a Registered Nurse (RN)
- Basic Life Support (BLS) through American Heart Association (AHA) or American Red Cross
- Working knowledge of multiple clinical areas, financial and data analysis, reimbursement practices, preadmission and concurrent review practices
- Advanced understanding of payer issues
- Experience with licensing and accreditation standards, regulatory standards, Utilization Review methodology and theory
- Knowledge of multiple database systems; clinical, financial, and registration
- Advanced knowledge of information, data, and project management
- Advanced knowledge of unit operations, performance improvement/utilization management, regulatory and professional standards, evidence-based practice patient safety/risk management, and outcomes management
- Strong clinical nursing experience and clinical judgment
- Master's degree and demonstrated experience in Project Management, Change Management, and/or Program Development are preferred
Benefits
Comp & perks- Endless support and appreciation
- Investment in health, well-being, and future
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Utilization ManagementClinical NursingData AnalysisPerformance ImprovementConcurrent Review PracticesPayer IssuesRegulatory StandardsEvidence-Based PracticeOutcomes ManagementFinancial Analysis
Soft Skills
LeadershipCollaborationClinical JudgmentCommunicationProblem-Solving
Certifications
Registered Nurse (RN) LicenseBasic Life Support (BLS)